Individual provider Active NPI

Sergey Gukasov, M.D.

  • Anesthesiology Physician
  • Charleston, SC
National Provider Identifier
1629480132
Registry record updated Jun 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
LL36861 Issued in SC
Practice address
169 Ashley Ave
Room 202 Main Hospital, Msc333
Charleston, SC 29424-0001
Phone
(843) 792-2437
NPI assigned
Jun 2, 2014
Last updated
Jun 2, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X LL36861 SC Primary

Addresses

Primary practice location

169 Ashley Ave
Room 202 Main Hospital, Msc333
Charleston, SC 29424-0001

Mailing address

169 Ashley Ave
Room 202 Main Hospital, Msc333
Charleston, SC 29424-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180814001634 NC Practitioner - Anesthesiology 5698064616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Michigan State University College of Human Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians

Practice addresses (Care Compare)

2525 Court Dr
Gastonia, NC 28054-2140
Phone (704) 834-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina Anesthesia Associates, PLLC Anesthesiology CurrentSince Aug 1, 2018 Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1629480132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294240001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "address_2": "ROOM 202 MAIN HOSPITAL, MSC333",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294240001",
            "telephone_number": "843-792-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUKASOV",
        "first_name": "SERGEY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-02",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "LL36861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.